PMHNP-63 Exam Reported Questions and answers

What is dissemination? Getting the research information out to those who need to know it! Publication - highest level Presenting at National Conference Presenting at Local Conference Journal Club where one person reviews an article What does a 17 on MMSE mean? Moderate cognitive impairment What is Tegretol in the CYP450 system? Inducer -->will lower dose of Lamictal and BCP's What do BCP's do to Lamictal? Inducer - will lower Lamictal effects What is a Type I research error? There IS a difference but you say there isn't a difference. What is a Type II research error? There is NO difference but you say there is a difference. What is pseudo-dementia? Cognitive impairment secondary to depression that clears when treated in the elderly. Tx depression Is it normal for a 1 month old to have a palmar grasp? Yes. What is a drug 1/2 life? The time it takes for 50% of a drug to be eliminated from the body. What 3 atypicals can be used with teens? Zyprexa, Abilify, Seroquel - low doses What is a risk of using Tramadol? Serotonin Syndrome as it is very serotonergic. What is the allele seen in Asians that increase the risk of SJS? HLAB-1502 How many generations do you include for a genogram? 3 What does messenger RNA code for? Amino Acids What is epigenetics? Factors that affect genes - environmental, smoking, stress What part of the brain is involved with OCD? Basal Ganglia Occipito-Frontal What happens to the brain during adolescence? Dendritic pruning Emotions are controlled by amygdala By adulthood, PFC involved as well When do males typically present with schizophrenia? 18-25 When do females typically present with schizophrenia? 25-35 yo What does Trileptal and tegretol do to EES? Trileptal (inducer) Erythromycin (inhibitor) Decreases the effects of EES Erythromycin interferes with liver microsomal metabolism of carbamazepine, causing Decreased carbamazepine clearance, an elevated serum carbamazepine level, and clinical toxicity What are some psychiatric side effects seen with some asthma drugs agitation, aggression, anxiety, hallucinations, depression, insomnia, SI, tremor What should you watch for with Tegretol? Agranulocytosis and Hyponatremia Which one of the 3 muscle enzymes are related to cardiac muscle damage? CKMB What is the risk of a seriously elevated CKMB? Polymyositis & Rhabdo What is a normal CKMB? 0.3 mcg/L What psychoactives does Detrol interact with? Topamax What CN are you assessing when you have the patient shrug their shoulders? CN XI - Spinal Accessory What do you see in labs with HIV & Dementia? CD4 <200 Viral Load is high <20% get it with antiretroviral treatment What is the scoring with the Beck Depression Inventory? (Self-Report - 0-63) 0-13 - minimal 14-19 - mild 20-28 - moderate 29-63 - severe What is sensitivity? Helps rule-out disease = SN-OUT What is specificity? Helps rule-in disease = SP-IN What is a normal sed rate or ESR? 0-22 males 0-29 females What does a decreased retic count indicate? Anemia - acute or chronic bleeding What does an increased retic count indicate? Bone marrow disorder or Vitamin Deficiency What happens when you mix tegretol and macrolides? Increase tegretol levels. What labs do you get with RA? Sed rate, RF, ANA, C reactive protein, CBC, CMP, CRP - helps confirm diagnosis. CRP and ESR are both increased in RA but NOT in osteoarthritis. Where does the NP Code of Ethics come from? ANA When do you assume informed consent? Unconscious Incompetent Life Threatening Situation What are the legal ramifications of treating w/o informed consent? Same as with informed consent Who can declare a patient incompetent and appoint a guardian? Only a court Does impaired judgement mean one is incompetent? No. Can an advanced directive ever be revoked? Yes, at any time. What is the different between a Healthcare Agent, Proxy, Surrogate, and Attorney in Fact? Nothing. They are all the same. Does the de facto rule of proxy apply in same sex marriages? No. How do Asians see HC providers? As in a position of authority. Expect to give instructions and help make decisions What does it mean when an Asian patient does not make eye contact with the NP? SIgn of respect What is the evil eye? When a stronger or more powerful person looks at a weaker person - often infant/child resulting in a hex which presents in illness such as HA, fever, diarrhea, disturbed sleep, increased fussiness. How do you protect from the evil eye? Red ribbon on an infant Amulet for adults How do you treat for evil eye? Access traditional healer + traditional care. For there to be a duty to a patient, what must exist? Relationship What is a proximate cause? The breach caused the alleged injuries. and without the act, no harm would have been inflicted. The injury was reasonably foreseeable. For there to be damages, what must exist first? Negligence Who sets the minimum requirements for NP's? State Board of Nursing Where does 50% of healthcare funds come from? The government What is incident to billing? Means MD initiates treatment and NP is an extension of the care and directly under the supervision of the MD. Allows NP to get reimbursed at 100% rather than 85%. How are Medicaid benefits determined? State determines qualification - Partnership between State and Fed Govt. Must be impoverished, US resident and low low income. Can you have Medicare and Medicaid? Yes, impoverished elderly but Medicaid is always payor of last resort. Is dental care included in Medicaid? Yes, <21 gets basic dental What is the purpose of HIPAA? National standards for electronic HC transactions National ID for providers, health plans and employers. Not SIMPLY Confidentiality. What must be signed prior to any healthcare in the state Notice of Privacy Practices Statement What happens if a patient refuses to sign an ROI? Can decline to treat Health plan may condition enrollment on provision of consent When is HIPAA not required? Emergency treatment Substantial communication barriers and consent is inferred Involuntary committment Is it ok to announce a patient's name in a waiting room? Yes, no other way to give care. Is it ok to leave a message on a patient's vm? Yes, but should be limited. What is the impact of steroid inhalers on children? Slows bone growth and may decrease ultimate height. What is the long-term impact of using steroid inhalers? Cataracts, glaucoma, thinning of bones and skin What is included in the treatment of fibromyalgia? Sleeping meds Antidepressants Pain meds